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Background: We aimed to summarize the outcomes of ulcerative colitis (UC) patients receiving an ileal pouch-anal anastamosis (IPAA) over an 11-year period at a high-volume Canadian inflammatory bowel disease (IBD) center., Methods: A retrospective chart review was performed for subjects with UC who underwent IPAA between 2002 and 2013. Patient charts were reviewed for demographic data, clinical characteristics, preoperative medical treatment, and surgical outcomes. Univariate and multivariate logistic regression modeling were used to determine significant factors in postoperative outcomes., Results: Seven hundred fifty-eight were included from the IBD database. The median age at the time of surgery was 37.1 (±12.1). Mean preoperative disease duration was 8.1 years (±8.7). Three hundred sixty-nine patients (48.7 %) had systemic corticosteroids (>15 mg/day) within 30 days prior to surgery. Of these, 286 patients had high dose (>30 mg/day) corticosteroids within 7 days of their first surgery. One hundred nine (14.0 %) IPAA procedures were performed laparoscopically. Pelvic pouches were created in traditional 2 (n = 460) and 3 (n = 285) stages; the remainder (n = 13) was performed in non-traditional staged operations. Early complications, defined as occurring within the same stay in hospital, consisted of pelvic abscess (n = 135, 17.8 %), small bowel obstruction (n = 134, 17.7 %), wound infection (n = 108, 14.3 %), and deep vein thrombosis (n = 33, 4.4 %). The overall pouch leak rate was 92 (12.1 %). There was one death in our study. The median length of stay was 10.3 days (SD6.0). Late complications, defined as occurring after discharge from hospital, consisted of anal stricture (n = 55, 7.3 %), pouch fistula (n = 26, 3.4 %), and functional pouch failure (n = 7, 0.9 %)., Conclusions: IPAA has been found to be a safe and effective method of surgical management of UC patients in a high-volume IBD center.

Purpose: Ileal pouch anal anastomosis (IPAA) is the procedure of choice in patients requiring surgery for ulcerative colitis (UC) and familial adenomatous polyposis (FAP). There are few data on reconstruction with the IPAA in patients with colorectal cancer (CRC). This study assessed the outcomes of the IPAA compared to proctocolectomy and permanent ileostomy (PI) on these patients., Methods: Between 1983 and 2013, over 2800 patients with CRC have been treated at the Mount Sinai Hospital (MSH). Demographic, surgical, pathological, and outcome data for all patients have been maintained in a database-73 patients were treated for CRC with proctocolectomy: 39 patients with IPAA and 34 patients with PI. Clinical features, pathologic findings, and survival outcomes were compared between these groups., Results: Each group was similar with respect to gender, stage, and histologic grade. Patients undergoing IPAA were significantly younger. The diagnosis leading to proctocolectomy was more commonly UC or FAP in patients treated with IPAA (39/39 vs. 23/34, p = 0.001). Rectal cancer subgroups were similar in age, sex, TNM stage, T-stage, height of tumor, and histologic grade. There was no significant difference in overall or disease free survival between groups for colon or rectal primaries. Analysis using the Cochran-Armitage trend test suggests that utilization of IPAA has increased over time (p = 0.002)., Conclusions: The IPAA is a viable and safe option to select for patients who would otherwise require PI. Increased experience and improved outcomes following IPAA has led to its more liberal use in selected patients.

Background and Aims: Fistulous disease is common in Crohn's disease, and entero- and colocutaneous fistulae are particularly debilitating and difficult to manage. We present the results of surgical management of these fistulas., Patients and Methods: Retrospective chart review of all 51 patients with Crohn's disease (56 surgical procedures) undergoing surgery for cutaneous fistulae between 1983 and 2000., Results: Previous surgery for Crohn's disease had been carried out in 43 patients (84%). The fistula site was enterocutaneous in 36 patients (64%), colocutaneous in 12 (21%), and anastomotic in 8 (14%); 9 patients (16%) also had associated enteroenteric fistulas. The onset of the fistula followed abscess drainage in 15 (27%) and occurred at the site of recurrent disease in 41 (73%). Forty patients (71%) initially underwent conservative management prior to surgery; 16 (28%) underwent surgery directly. Surgical procedures were: 25 ileocolic resections, 8 stoma revisions with resection, 8 small bowel resections 7 subtotal colectomies, 4 partial colectomies, 3 proctocolectomies, and one fistula tract excision. Mean total length of stay was 18 days (postoperative 10.7 days). Six (11%) patients had eight postoperative complications. Mean follow-up was 48.6 months (range 3-187). Recurrence as defined by either clinical examination or reoperation was documented in nine fistulas (16%), with a mean time to recurrence of 27 months., Conclusion: Entero-and colocutaneous fistulae usually occur from a site of active disease. Surgical management with bowel resection, including the fistula, is the preferred method of treatment. Morbidity has been low and recurrence rate lower than expected., (Copyright 2004 Springer-Verlag)

This retrospective study determined whether a hand-sewn or stapled anastomosis leads to a greater recurrence rate in patients undergoing ileocecal resection for terminal ileal Crohn's disease. The effects of oral contraceptive use, smoking, and age at onset of disease were also examined. Ninety-two patients with Crohn's disease of the terminal ileum whose first operation was an ileocecal resection (terminal ileum and right colon up to but not including the hepatic flexure) were studied for symptomatic and operative recurrence. The symptomatic recurrence rates were 15% at 1 year, 31% at 2 years, and 45% at 3 years. The operative recurrence rates were 6% at 1 year, 14% at 2 years, and 22% at 3 years. The type of anastomosis, whether hand-sewn or stapled, did not affect the rates of symptomatic (P = 0.3) or operative (P = 0.6) recurrence. After the initial resection smoking affected both symptomatic (P = 0.03, risk ratio = 2.380) and operative (P = 0.041, risk ratio = 3.13) recurrence, but there was no effect of age at onset of disease or use of the birth control pill.

Objective: To evaluate the pregnancies, deliveries and functional results of patients who have undergone and ileal pouch-anal anastomosis., Design: A retrospective survey by questionnaire., Setting: The study was conducted at a university hospital., Subjects: Twelve women who had undergone an ileal pouch-anal anastomosis at the Inflammatory Bowel Disease Centre, Mount Sinai Hospital and who had subsequently become pregnant, were identified from the hospital records. A follow up questionnaire was completed by all subjects., Results: Twelve patients had 16 deliveries. There were 10 vaginal deliveries and 6 caesarian sections. There were no pouch-related complication during the 16 pregnancies and there were two postpartum complications., Conclusions: Pregnancy is safe in women with an ileal pouch-anal anastomosis. Functional results are altered minimally. Vaginal delivery is safe and obstetric reasons should determine whether a caesarian section is performed.

Although scintigraphic pelvic pouch emptying scans have been used to evaluate neorectal function in patients who have undergone colectomy, mucosal proctectomy, and ileoanal pouch anastomosis, previous reports have not documented the reliability of this test in measuring pouch volume and emptying. Thus, this study was undertaken to determine: (1) the reliability of this test in patients with stable functional results and, (2) whether the emptying fraction correlates with the volume of the pouch. Ten patients who had stable functional results had 99m Tc-sulphur colloid pouch emptying scans performed on two occasions, one week apart. The average volume of artificial stool that was instilled was 338 +/- 104 cc. The mean difference in the volume instilled between the initial and repeat scans was 78 +/- 26 cc and the mean absolute difference in the percentage evacuated was 12 +/- 9 percent. These inter-test differences were not statistically significant (p greater than 0.05). There was no correlation between the volume of artificial stool instilled into the pelvic pouch and the fraction spontaneously emptied (r = -0.1). Our results suggest that the 99m Tc-sulphur colloid pelvic pouch emptying scan is reliable in patients with stable functional results. Pouch emptying fraction is independent of pouch volume.

Between December 1981 and March, 1987, 188 ileal reservoir and ileoanal anastomosis procedures were performed at the University of Toronto. Anal anastomotic complications occurred in 24 (12.8%) patients. There were 19 patients who developed a leak as a result of non-healing of the ileoanal anastomosis (group 1). Late fistulae occurred in 5 patients (group 2). Various treatments were employed. In group 1, 2 of 15 (13%) patients treated with drainage and antibiotics, 3 of 7 (43%) in whom the anastomosis was resutured, and 5 of 7 (71%) in whom repair was performed by advancing the ileal outlet and resuturing the anastomosis, healed their anastomosis. One patient was treated successfully by performing a fistulotomy. Treatment was unsuccessful in one patient in whom the ileal reservoir and ileoanal anastomosis were revised and re-anastomosed. One patient (50%) in group 2 was treated successfully by advancing the ileal outlet and resuturing the anastomosis. Complete healing of the anastomosis was achieved in 12 patients (50%), although 3 patients subsequently required excision of the reservoir because of inability to evacuate spontaneously (1), incontinence (1), or psychological reasons (1). All nine (38%) patients who were functioning with their ileal reservoir were continent. One patient intubated the reservoir. The rate of urgency and soiling, and the number of bowel movements per 24 hours did not differ significantly from those of patients without these anastomotic complications. Our results suggest that early diagnosis and repair of ileoanal anastomotic dehiscence by advancement of the ileal outlet and resuturing of the ileoanal anastomosis results in improved reservoir salvage and satisfactory functional results.